OncoLink Exclusive: An Interview with Anil Rustgi, MD

Kristine Conner OncoLink Last Modified: March 27, 2002

Anil Rustgi, MD, the T. Grier Miller Associate Professor of Medicine and Genetics and the Chief of the Division of Gastroenterology at the University of Pennsylvania, was one of just eight medical researchers recently asked to serve on the medical advisory board for the National Colorectal Cancer Research Alliance (NCCRA). The NCCRA, which officially launched this month and was co-founded by journalist and Today show host Katie Couric and cancer fundraising activist Lilly Tartikoff, is a new organization devoted to public education about colorectal cancer and fundraising efforts that will support research into prevention, detection, and therapy.

Dr. Rustgi specializes in the molecular biology of colon cancer, chemoprevention, and molecular diagnostics - in other words, he works to understand what happens at the molecular level when someone develops colon cancer. As a member of the advisory board, he is working alongside researchers from such world-class institutions as the UCLA Jonsson Comprehensive Cancer Center, Vanderbilt University Medical Center, M.D. Anderson Cancer Center, Dana Farber Cancer Institute, Johns Hopkins Medical School, and the Harvard School of Public Health. The board met a few times before the project's official launch on March 1st, and they are scheduled to meet again in October. "But we're all in communication through other means," says Dr. Rustgi, "and constantly in communication with the NCCRA."

The project's first priority has been to raise public awareness about screening, risk factors, and prevention of colon cancer. "Historically, efforts that enhance public awareness really have needed to be focused - and people who are well-known serve as catalysts," Dr. Rustgi told OncoLink. "It took years before screening for breast, cervical, and other cancers became part of the public consciousness. Such a concerted, consistent effort has not happened with colon cancer until now. This is likely to have a great impact on screening."

He says that Penn's Division of Gastroenterology has already experienced a surge in inquiries by phone and email as a result of its participation in the project. Its contact information is listed on the NCCRA Web site, and many people who call the NCCRA's toll-free number are also being directed to advisory board members' institutions. "There's an outpouring of inquiry and interest that I haven't seen before," says Dr. Rustgi. "We've specifically indicated an interest in high-risk families, but people with average risk are calling as well. The key will be to sustain this, and Katie Couric's effort will be a driving force."

Much of Dr. Rustgi's research focuses on people with familial forms of colorectal cancer, which often develop before the age of 40. Familial Adenomatous Polyposis (FAP) is a rare, inherited condition that leads to the development of hundreds or thousands of adenomatous (originating in the glands) polyps in the colon and rectum, usually at a young age. Unless this condition is treated, people who have it are extremely likely to develop colorectal cancer by the time they reach age 40. Hereditary Nonpolyposis Colorectal Cancer (HNPCC) is another inherited form that tends to develop at a young age, often without the presence of polyps. Even though these syndromes account for just a small percentage of all cases of colorectal cancer - most develop sporadically, with no family history - they can provide important clues about the disease in general.

"One often gets a great deal of mechanical insight and clinical application in general from familial forms of cancer," says Dr. Rustgi, citing the example of research into the BRCA gene for breast cancer. "And it's easier to research familial forms because they are more exaggerated. Plus, many of the genetic changes that people acquire over time, and which lead to colorectal cancer, are similar to the genetic abnormalities that are present in the familial syndromes."

Understanding the genetics of colorectal cancer, he says, has great potential to improve the ways we diagnose and treat it. Right now, we know that early detection and removal of precursor lesions, or polyps, can effect cure in nearly 90% of cases. But the future holds possibilities for developing blood and stool tests that could detect genetic markers for the disease even before polyps are present. Testing for genetic abnormalities could also help with determining patients' prognosis and monitoring the likelihood of recurrence. For instance, people with a certain number of genetic abnormalities might be treated more aggressively - say, with post-operative chemotherapy as well as surgery - than those with fewer. And genetic research also could lead to innovative therapeutic approaches that target certain genes in cancer cells. That is why researchers at the University of Pennsylvania are working to improve understanding of how genes are involved in the progression from polyp to cancer.

The Division of Gastroenterology also provides comprehensive clinical care. Through the high-risk colorectal cancer clinic, people with strong family histories of the disease can work with a genetic counselor as well as physicians. The gastrointestinal oncology clinic offers screening and treatment, and people with advanced forms of the disease can participate in large-scale, multicenter clinical trials that are evaluating new treatment approaches.

Dr. Rustgi says he feels fortunate to have been asked to be part of the landmark effort that NCCRA represents, and even more fortunate that Penn will be one of the eight institutions receiving some of the money generated by NCCRA's eventual fundraising efforts. In the meantime, he says, it is "imperative" that people discuss regular screening with their physicians and do what they can to modify their risk: exercise regularly, take one multivitamin a day, and decrease red meat consumption. He says it's also been shown that long-term aspirin use can reduce risk, although the optimal dose in unclear. It's not appropriate for everyone to take aspirin, though, so individuals should discuss this with their doctors. Calcium is also under investigation as a chemopreventive agent.

Just as it's important for people to overcome their fear of or aversion to screening, they also shouldn't assume that a diagnosis of cancer means automatic colostomy. In most cases, the cancerous tissue can be removed and the colon resected - and it functions just as it did before. Unless the cancer has spread or the tumor is in an odd location, says Dr. Rustgi, "surgery often doesn't have to be as radical as people assume it will be."